Claiming PFL Benefits

Anonymous User

1199

Associate

House Staff

RN-NYSNA

Teamsters

Anonymous User

Associate

House Staff

RN (NYSNA)

RN (1199)

1199

Local 30

Claiming Benefits

You will need to file a Request for Paid Family Leave and provide documentation to support your Paid Family Leave request. There is one claim form packet for each leave type under PFL: Bonding, Caregiver, or Military Exigency. Within 18 days of filing a complete claim for benefits, Montefiore’s Paid Family Leave insurance carrier will issue PFL benefits or deny the claim and provide an explanation of the denial.

Appropriate documentation includes:

For Birth:

The birth mother will need:

Birth Certificate, or

Documentation of pregnancy or birth from a health care provider (includes mother’s name and due/birth dates)

A second parent will need:

Birth Certificate, or Documentation of pregnancy or birth from a health care provider (includes mother's name and due/birth dates). If the 2nd parent is not named on the birth certificate, the 2nd parent must provide an acknowledgement of paternity, order of filiation or other evidence of relationship with the parent named by medical provider or birth certificate.

Voluntary Acknowledgement of Paternity, or

Court Order of Filiation, or

Copy of documentation for birth mother (above) plus second document verifying relationship to the mother.

For Foster Care:

Letter of placement issued by county or city department of social services or local voluntary agency

If second parent is not named in documentation, a copy of that document plus a second document verifying relationship to the parent named in the foster care placement.

For Adoption:

Legal evidence of adoption process

If the 2nd parent is not named on the birth certificate, the 2nd parent must provide:

Voluntary Acknowledgement of Paternity, or

Court Order of Filiation, or

Second document verifying relationship to the mother or the child.

For a Family Member’s Serious Medical Condition:

Certification from the Care Recipient's Health Care Provider

For Military Service:

US Department of Labor Military Family Leave Certification (Federal Military Leave Form)

Copy of Military Duty Papers

Other documentation supporting the reason for the leave (copy of meeting notice, ceremony details, rest and recuperation orders, etc.)

This site provides only highlights of the Montefiore‘s Benefits & Wellness Programs and does not attempt to cover all details. Complete details are contained in the Plan documents and/or insurance company contracts, which legally govern the Program and which are controlling in the event of the conflict. Montefiore expects to continue these plans indefinitely, but reserves the right to change, modify or terminate the Plans in whole or in part, at any time and for any reason. In addition, the tax treatment of these benefits is subject to change without notice, as determined by federal, state or local tax authorities.